Last century, low vision services were regarded as a last resort and an admission of failure. Generally, when patients enquired as to whether there was anything available to help them see, the answer was either a tentative, ‘you could buy a magnifier’ or a more defensive, ‘you’re not bad enough for that yet’.
When medical and surgical options ran out, the patient was dismissed with ‘there is nothing more that can be done, sorry’. This was effective at getting the patient out the door, but left them emotionally and physically stranded, unable to comprehend how to function visually when they were neither blind nor seeing. More patients were rendered functionally “blind” by this statement than by any other documented pathology and, sadly, many continue to exist in this state today, convinced this statement remains true as it was given by those they trusted.
For some, this attitude has continued into this century, despite huge changes in medical, optical and electronic technology, and the current view of low vision as a spectrum of functional changes that occur along the pathway between normal vision and no light perception. A few weeks after I started my low vision practice in 2011, I ran into an ophthalmological colleague who told me, ‘I hope you never get to see any of my patients!’ But for many, there has been a shift in thinking towards understanding that visual function cannot be defined by the size of letter read on a high-contrast distance chart or a monocular electronic visual field analysis; and visual rehabilitation does not mean restoring vision to normal, but the rehabilitation of a person with visual loss to function within their family, whanau, community or workplace.
Much of this change has been driven by the realisation that even with the amazing advances in medical science in the management of ongoing problems such as glaucoma, macular degeneration or other retinopathies, it is just that – management of the condition – not restoration of normal visual function. Thus, the best outcomes are obtained when patients are given as much information as possible on the range and type of additional services available to them sooner rather than later when all else has failed.
Today, the modern low vision consultation reviews how a patient with low or declining vision functions in their everyday environment and how we can help them use the vision they have more efficiently to manage their day-to-day activities. This involves taking a holistic view incorporating their general health, and the impact of perhaps other health problems such as stroke, Parkinson’s or diabetes on their visual functioning; and their physical environment – are they confined to one, poorly-lit room in a rest home or actively participating in sport or looking after other family members? Does their visual problem extend to passive reading or do they have other needs such as mobility or glare control? Is there a history of amblyopia, binocular vision instability or balance problems that has been forgotten along the way or considered irrelevant due to the patient’s poor distance acuity? Has the need for prescription glasses to focus at near range been overlooked as their vision deteriorated? Or do they perhaps simply need reassurance there are options available to help them if and when they need it?
